Q&A: Dr. Martin Leland on Meniscus Injuries

It was a painfully familiar scene for Chicago Bulls fans: Derrick Rose limping off the court, again. After making a backdoor cut in the third quarter of last Friday’s game against the Portland Trailblazers, Rose hobbled back up the court with an apparent knee injury. Now we know that he tore a meniscus in his right knee, just 10 games into his comeback from tearing the ACL in his left knee in 2012.

Rose had surgery on Monday, but will miss rest of the season. Just as we did the last time the Bulls’ former MVP went down with a season-ending knee injury, Science Life spoke to orthopedic surgeon Martin Leland, MD, about what it means to tear a meniscus, how they are repaired and what this means for D-Rose’s future.

Let’s start with the basics: What is the meniscus?

The meniscus is a soft tissue disc in the knee. We have two per knee, one on the inside and one on the outside of each knee. They basically act as a shock absorber in the knee as we walk and run. It’s composed of a fibrous material and it’s C-shaped.

Is it something that athletes injure a lot, or was this unusual?

It is something that athletes injure a lot, but as we know, it’s not like athletes are going down every single game with meniscus tears. As a sports medicine surgeon, dealing with torn menisci is the most common surgery that I do by far. If I do 300 cases a year, 200 of them are probably meniscus tears. So this is a very common injury overall.

J. Martin Leland III, MD

Is this injury more or less serious than when he tore his ACL?

It’s much less serious. Recovering from an ACL tear took Derrick 18 months. There’s no way this will take longer than 6 months, but unfortunately that’s the end of this season so we won’t see him until next year. But meniscus tears are definitely not as serious. Anyone would choose this over an ACL tear, because with an ACL you have to worry if it will heal well or it’s going to cause continued instability in the knee. You don’t have that problem with a meniscus.

When you watch the play where injured himself, he was just turning to head back up the court. He didn’t crash into anyone or do anything strenuous. How did this happen?

Meniscal tears can happen with much less force than tearing an ACL. When he tore his ACL, he was trying to stop the momentum of his body so he could jump straight up and shoot the basketball. But because he was running and his muscles were tired, his knee gave out. It wasn’t a high-velocity injury, and a meniscus tear is even more of a low-velocity injury. There is not that much force required. All you really need to do is rotate on your knee just the right way and you’ll tear the meniscus. In my patients, 50 percent of people don’t even remember when they tore the meniscus. They swear that they didn’t have any major injury, and I believe them. You pivot on your knee, and as you’re putting weight on your leg, the femur pushing down on the tibia catches the meniscus just right and tears it.

Do two knee injuries like this mean Derrick Rose is injury prone, or is it just bad luck?

I think it may have been the fact that he’s been so focused on rehabilitating his left leg. Players stay in shape by playing their sport. If you’re playing 80 basketball games a year, you’re going to stay in pretty good shape. But with him, he hasn’t been playing until this preseason, he’s just been training. So it’s possible that he had a muscular imbalance where his left leg is actually stronger than his right, and that’s what predisposed him to tearing his meniscus. But if he were really predisposed to injury, he probably would’ve never gotten to this point in his career because he would be constantly getting injured and no one would’ve taken a serious look at him. I think it’s just one thing after another. When you’re coming back from a major injury and extensive physical therapy like he did on his ACL, you do have an increased risk of getting injured again before you get back into the swing of things.

He and his doctors chose to have the meniscus repaired instead of removed. What’s the difference between those two procedures?

When you tear your meniscus there are two options: You either have it trimmed out [removed] or repaired. And typically whether you choose one or the other is determined by the type of the tear. There are certain types of meniscus tears where you put stitches in it and they heal very well, and there are other types of tears that do not heal very well no matter what you do. Those are the ones that are typically trimmed out. The younger and more athletic the patient, the more likelihood that you’re going to get a tear that’s repairable, as opposed to someone in their 50s or 60s who have a more degenerated, complex tear that is just trimmed out.

If it is a type of tear that can be repaired, it will hopefully heal down and protect the patient’s knee for the rest of their life, decreasing the risk of arthritis and making a more normal knee. But the recovery time is much different: 4-6 weeks if you have a meniscus trimmed versus 4-6 months if you have it repaired. So it’s a much faster recovery if you have it trimmed out, but you’re left without your meniscus and you have a much higher likelihood of developing arthritis down the road, which is definitely a killer for a professional athlete. If they develop knee arthritis they’re done. It’d be in a matter of 5-10 years, but still, I can understand Derrick not wanting to be a crippled 35-year-old. Neither would I. In the long term, it’s definitely better to have the meniscus repaired, but in the short term that means going the whole season without Derrick Rose.

Does the fact that’s he’s now required surgery for both knees make him worse off in the long run?

No, I don’t think so. With meniscus repairs there’s a 20 percent chance of needing additional surgery, so it’s always possible that it may not heal and he’ll need surgery again, but again that’s only a 1 in 5 chance. So most likely he should be fine next season. Now when he returns next season let’s hope something else doesn’t happen because his luck isn’t great these days, but hopefully it will heal well, he’ll get back next year and he’ll be the Derrick Rose that we all miss.

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For more, here’s a behind the scenes video of Dr. Leland speaking to CBS 2 Chicago about Rose’s injury:

And here’s a quick overview of meniscus injuries with Dr. Leland produced for Chicago Blackhawks games a few seasons ago:

Ed. note, February 2015: Since this article was published, Dr. Leland has moved on to become the medical director of sports medicine at University Hospitals Geauga Medical Center in Cleveland, Ohio. Science Life thanks him for his many contributions to this blog.